Femtosecond phacoemulsification'un ticari ve tıbbi yönleri

HalilAtes 7. Ocak 2012 11:51

Current Opinion in Ophthalmology'nin Ocak 2012 sayısında Fentosecond fakoemülsifikasyonun ticari ve tıbbi felsefesini ve işlerliğini yorumlayan müthiş bir makale yayımlandı, bir bölümünü sizlerle paylaşmak isterim;


"Important considerations for adopting this technology include cost of the femtosecond machine, space, personnel and marketing. Currently, only the LensX machine is commercially available in the USA. In the future, the entry of competing platforms will provide more equipment options and lower femtosecond acquisition costs. A practice also has to consider the cost of additional space to house the femtosecond laser suite. One option is to provide a room large enough to contain both the femtosecond laser and the phacoemulsification machine so that both procedures can be performed in one room. Although this option minimizes patient and surgeon movement, it also prevents continuous use of the femtosecond unit. Another option is to have a dedicated femtosecond room and operator who continuously performs the femtosecond portions of the procedure (LAC, LLF, corneal incisions).

The patients are then transferred to the phacoemulsification room for cataract removal. This latter system creates a need for coordination between the two rooms. Ideally, the distance from the femtosecond to phacoemulsification rooms should be short to minimize transport delays. Additional personnel will be needed to incorporate femtosecond cataract surgery. These include the femtosecond operator, which may be a technician or surgeon. Practices with an existing femtosecond flap maker may utilize the same operator for femtosecond cataract surgery. Clinic staff should also be trained to counsel patients on the merits and risks of femtosecond cataract surgery and premium IOLs. A marketing plan is essential to generate patient interest in this new procedure and will entail additional costs (brochures, advertisements, website). The last but all-important issue is how to recover the cost of adopting the technology. Medicare and commercial payers already cover the cost of the cataract procedure. Neither surgeons nor facilities can charge Medicare or commercial payers additional amounts for using the femtosecond laser to perform cataract surgery. However, surgeons are allowed to charge patients directly, as a noncovered procedure, for femtosecond corneal and limbal relaxing incisons for the treatment of pre-existing astigmatism, which is present in significant degrees (>0.75 D) in about a third of the population. An appropriate informed consent should be obtained in which patients document their understanding of the procedure, the treatment alternatives, and request for the femtosecond cataract surgery as a refractive procedure."



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Prof. Dr. Halil Ateş



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